Aids Infection From Doctors Unlikely, Care-givers Say

Should All Physicians Be Tested? 'There Are No Clear-cut Answers'

The people who care for Carroll countians when they're sick say the same precautions they take to protect themselves from AIDS also will protect their patients.

The death from acquired immune deficiency syndrome of Dr. Rudolph Almaraz, a breast-cancer surgeon from Johns Hopkins Hospital in Baltimore, has touched off discussions in the health-care industry about guidelines for when care-givers carry HIV, theAIDS virus.

Carroll County health professionals contacted said they feel theyare more at risk for catching something from a patient than transmitting a disease to one.

"We don't bleed on our patients, we don't sneeze on our patients, we don't urinate on our patients," said Dr. Michael Stang, chief of emergency medicine at Carroll County General Hospital.

Sick or injured patients, on the other hand, sometimes bleed, urinate or vomit on health-care workers, he said.

But Stang and others said that by following "universal precautions" of using gloves and masks when dealing with bodily fluids of any patient, they will protect themselves and their patients from infections. The precautions are taken because workers don't always know who might carry HIV or the more common hepatitis B, also transmitted through direct blood-to-blood or sexual contact.

The Maryland Hospital Association and the state are discussing whether hospitals may ask physicians to be tested or to disclose test results for the AIDS virus. Currently, the state regulations are that hospitals assess the "current mental and physical health" of doctors.

CCGH does not employ physicians, but offers them privileges to treat their patients there. Dr. Edward Carter, a radiologist who is chief of the medical staff at CCGH, said he wouldn't support routine AIDS testing of physicians.

"I feel a responsibility to the public," Carter said, adding, however, the privacy rights of individual doctors would be threatened by such testing. "There are no clear-cut answers."

The Maryland Hospital Association this year also is exploring routine drug testing, which Carter still isn't sold on. But drug use at least is something that would impair a doctor's judgment and skill, he said, while an HIV infection would not.

"There are probably as many different opinions in health care as on the street," said Joan Spear, director of peri-operative services at CCGH and a registered nurse. "Some are opposed, some think it's wonderful."

Spear took a deep breath before giving her own opinion.

"I'm not opposed to mandatory testing," she said. "As a professional, I want to reassure the patient we're doing everything we can to(ensure their safety)."

But when asked what should be done with aworker who tests positive for AIDS, Spear said she didn't know.

"You need more information and results from studies. What risk does that present? I don't know the answer to all those questions."

Dr. Ira T. Bloom of Manchester Dental Center said any dentist practicing today "should be sterilizing everything. Any dentist should take precautions, and then the risks are nil."

Bloom said he still is skeptical of a report earlier this year by the Centers for Disease Control that a Florida woman may have gotten AIDS from her dentist, who sincehas died of the disease.

"I don't see how it could happen," Bloomsaid.

He said if dentists ever prick or cut themselves with theirinstruments, it is usually after a patient has left and they're cleaning up.

Nationwide, the Florida case is the only one in which scientists believe a health-care worker infected a patient with AIDS, while 37 health-care workers are believed to have gotten the disease treating infected patients, as Almaraz' lawyer claims the surgeon did.

Although hospitals don't routinely test employees' blood for HIV or any infections, CCGH's policy for employees known to be positive for AIDS or hepatitis B is that the employee may continue to work, but must be counseled about how to protect patients from being infected, said Libby Fuss, employee health/infection control nurse. The policy follows the latest recommendations from the CDC, she said.

Fuss said she has not dealt with an HIV-positive employee. Some employees have had hepatitis B, but were not carriers.